In 2010, the Palliative Care Research Cooperative Group (PCRC) was developed as a national collaborative research network to become the scalable, supportive structure so critically needed for the conduct of high quality clinical trials Work proposed under the current grant will build on the accomplishments achieved during the initial NINR funding for the PCRC (UC4NR012584). The overarching objective of this U24 grant application is to amplify the role of the PCRC as a national resource for efficient conduct of high quality, collaborative, multisite, palliative care and end-of-life (PCEOL) research by leveraging and building upon the prior NINR investment and accomplishments of the PCRC to date. The steps planned for further PCRC development will enable it to: (1) support research and develop expertise in understudied PCEOL areas such as caregiver and bio-behavioral research; (2) facilitate efficient and expeditious conduct of important, cutting-edge studies that require large samples and multiple sites; (3) prepare future researchers to utilize and sustain the enterprise, while continuing to build the PCEOL evidence base, and; (4) describe, quantify, and understand the risks, issues, and impact of life-limiting disease on multiple relevant outcomes including health outcomes for patients and caregivers and bio-behavioral interventions and outcomes. Specifically, we propose to rapidly increase the capacity of the PCRC to develop and conduct a diversified portfolio of high quality research studies that are responsive to key gaps in the scientific knowledge. We will achieve these goals through the following specific aims: (1) develop a national research capacity for collaborative, multisite, PCEOL research in a way that maximizes the quality and efficiency of research and the effectiveness of cooperative groups; and (2) provide integrated support for PCEOL research, specifically, for the conduct, analysis, and dissemination of clinically meaningful, high-quality, efficient, patient-centered, multisite studies. The combined result of achieving these aims will be a highly efficient, adaptive, and standardized system to advance prioritized, innovative, rigorously designed and performed, studies in PCEOL research, with a particular emphasis on clinical trials requiring multiple recruitment sites.